By Louise D. Metz MD
Menopause can be a mysterious and daunting event for women, but it does not have to be! Women often enter perimenopause without enough information about what to expect during this transition, which can make this a challenging and isolating time. However, armed with knowledge and support, women can successfully navigate this transition. Menopause is a natural transition in a woman’s reproductive life in which estrogen levels decrease and menstrual cycles end as the follicles, or eggs, are depleted from the ovaries. A woman becomes officially post-menopausal when she has been without a menstrual period for 12 months. The average age of menopause is 51, though it can occur between the ages of 40 and 60. Perimenopause is the time period leading up to menopause in which menstrual cycle changes begin to occur along with other symptoms of hormone fluctuations. This menopause transition begins on average about 4 years prior to menopause.
The symptoms and timing of peri-menopause and menopause can be difficult to predict, as the experience is widely variable from woman to woman. As hormone levels begin to fluctuate, menstrual cycles can initially become closer together. Later in the transition, cycles become spaced farther apart, followed by periodic skipped cycles and eventual cessation of menstrual cycles. In addition to this irregularity in menstrual cycles, some women experience episodes of heavy or prolonged bleeding due to hormone changes.
Hot flashes and night sweats, known as vasomotor symptoms, are the other most common symptoms that occur during the menopause transition. Hot flashes often begin as a sensation of heat and flushing in the chest and face, can then affect the whole body, and typically last for a few minutes. The frequency and severity of hot flashes are different in each woman. Some women have frequent and severe hot flashes during the day and night, others have mild or occasional episodes, and a few have no hot flashes at all. These vasomotor symptoms typically last for up to 5 years, but in some women can last for many years.
We often underestimate the effects of even small changes in hormone levels on many systems of our bodies. Other common symptoms that can occur due to changing hormone levels during the menopause transition include sleep disturbances, depression and anxiety, heart palpitations, cognitive symptoms, headaches, changes in weight, and joint pains. Nighttime awakenings often occur, either spontaneously or due to night sweats. Many women experience fluctuations in mood, irritability, tearfulness, and anxiety, which can begin even before significant changes in menstrual cycles. Vaginal dryness gradually occurs over time due to thinning of the vaginal lining in the setting of the low estrogen levels, and this can be associated with pain with intercourse. Though these menopause symptoms sound unpleasant, we can be reassured that there are many ways to address and prevent the symptoms of menopause, including with medications, lifestyle changes, and complementary therapies.
The goals of management of the menopause transition are to improve quality of life and long term health and wellness. There are multiple modalities used to address menopause symptoms, including low dose birth control pills during perimenopause, hormone replacement therapy, topical vaginal estrogen, low doses of anti-depressants and other non-hormonal medications, herbal supplements, exercise and nutrition changes, and acupuncture. Recognizing and addressing the symptoms of menopause before they begin to significantly limit quality of life is essential. It is important for women to partner with their primary care provider, women’s health specialist, or gynecologist in the management of their menopause symptoms, as each woman requires a unique and personalized approach to her care.
The mysteries of menopause can be eliminated as women gain the knowledge, tools, and support needed to assist them in navigating their own unique menopause experiences.
Resources about Menopause:
The North American Menopause Society website:
Office on Women’s Health website: